Repair of Nasal Septal Perforation

Surgery Overview

The nasal septum is the structure between the nostrils that
separates the nasal passages. The septum, composed of cartilage and thin bone,
can develop a hole (perforation) in the cartilage as a complication of previous
nasal surgery, from cocaine use, excessive nose picking, trauma, cancer, or
diseases such as
tuberculosis,
sarcoidosis, or
syphilis. As damage reduces blood supply in the
septum, the cartilage begins to die, and a hole develops.

Some perforations can cause bleeding, pain, and a whistling sound
when inhaling. If dried blood or scabs build up, you could also have trouble
breathing through your nose.

Many perforations do not need to be closed. Small perforations may
need only frequent rinsing with
saltwater (saline) solutions and applying lubricating
gels. Both can be bought without a prescription.

Several surgical techniques may be used to close a larger
perforation. A surgeon may use tissue from inside your nose or from another
part of your body (autograft) to stitch into the hole. Other doctors may use
tissue to create a flap to cover the perforation.

What to Expect After Surgery

You will begin
rinsing the nose several times a day with saline. Your doctor will instruct you
on how to use the saline. You can expect drainage after surgery.

You may need to have your nose cleaned in the doctor's office a few
times. Your nose should be healed 2 to 3 weeks after the nasal pack is
removed.

Avoid blowing your nose, strenuous exercise, and bending forward
for a few days. Also take care not to injure your nose during exercise or other
activities.

Why It Is Done

Some nasal septal perforations can cause symptoms such as bleeding
and pain. Small perforations can create a whistling sound when you inhale. In
cases of long-term, severe perforation, the bridge of the nose can develop a
saddle-shaped deformity. Surgery can resolve these problems.

How Well It Works

Surgery to repair a nasal septal perforation is usually successful.
But some large perforations may be hard to close.

Risks

Bleeding and infection can occur after any surgery. You should
contact your doctor if you have:

Heavy bleeding. Mild bleeding is
normal.

A fever of
101°F (38.3°C) or higher.

Severe
pain. Mild pain is expected.

Pus.

A foul smell coming
from the nose.

A persistent headache.

Sometimes the perforation may reopen and need another
surgery.

What to Think About

Success of surgery depends to some extent on the size of the
perforation and also on proper
postsurgery care at home. Large perforations are more difficult to close.

The repair may not be as successful in people who smoke or have
diabetes as in other people, because these conditions
can reduce blood supply to the septum.

A doctor may want to try a nonsurgical technique to close the
perforation before suggesting surgery. In some cases, a doctor may insert
septal "buttons" made of silicone or other materials that are cut to fit the
perforation.

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